apex Flashcards
what is increased in the serum of the patient with renal osteodystrophy
2 p’s
phosphate and parathyroid
what is produced by the kidney
erythropoietin
renin
not antidiureitc hormone or angiotensin II
where is angiotensinogen produced
liver
where is angiotensin I produced
systemic circulation
what does a bun to creatine ratio of 30 suggest
inc bun/ cr ratio (> 10:1)
upper gi bleed
dehydration
inc protein intake
obstructive uropathy
creatine clearance
normal = 95-150
mild = 50-80
mod dysfxn= 10-25
severe dysxn <10
calculate gfr for a male
(140-age) x wt kg / (serum cr x72)
gfr calculation for a women
0.85 x ((140-age) x wt kg/ serum creatine x 72))
how does vasopressin increase gfr
constrict efferent
what tells concentrating ability of the kidney?
creatine clearance and fractional excretion of sodium
tubular fxn is measured by concentrating ability
what labs are liekly to be abnormal with ESRD
hgb and bleeding time
staging kidney dz
stage 1- inc cr 50% or uo < 0.5 ml/kg/hr for 6 hrs
stage 2- inc 100% or for 12 hrs
stage 3- inc 200% or for <0.3 for 24 hrs
what are causes of prerenal azotemia
chf, abd compartment syndrome, aortic artery clamping
intrarenal azotemia causes
acute tubular necrosis
vasculitis
intersitial nephritis
acute glomerulonephritis
best way for renal protect after major muscle trauma
mannitol
complications of sevo to pt with renal dysfunction
fluoride and compound A
what drugs cause hypokalemia (u waves)
bumetanide
metolazone
what diuretic worsens hyperkalemia
hydrochlorothiazide
what diuretic should be avoided in diabetic patient
hydrochlorothiazide- thiazide diuretics cause hyperglycemia
what diuretics cause ototoxicity
furosemide
ethacrynic acid
what kind of diureitc is indapimide
thiazide diuretic
inhibits na-cl transporter in distal tubule- dec reabsorption of na, cl, bicarb and water
what is mannitol likely to cause
hypoNa
pulmonary edema
where is the portal v located
between splanchnic circulation and liver
basin of blood leaving spleen, intestine, stomach, gallbladder and pancreas
what supplies 25% of liver blood flow
hepatic a. also supplies 50% of oxygen
how does propranolol reduce hepatic blood flow?
hepatic a. constriction
what part of liver is most susceptible to hypoxic injury
zone 3- near central vein- recieve the least amount of oxygen- most susceptible to hypoxic injury
most common cause of viral hepatitis
A
hepatitis msot likely to be transitted during a blood transfusion
b and c
most significant risks for halothane hepatitis
obesity and age > 40
femle; genetic predisposition; induction of cyp3e1 (alcohol, isoniazid, phenobarbital)
physiologic changes that accompany liver failure
restrictive pulm defect, thrombocytopenia
failing liver cannot clear endogenous vasodilators (VIP, glucagon) - it decreases response to vasopressors
what is used in child pugh score
albumin, pt, bilirubin, ascites, encephalopathy
what happens with cirrhosis
cell death- healthy hepatic tissue is replaced by nodules and fibrotic tissue- reduces number of functional hepatocytes and sinusoids
number of blood vessels in liver is reduced- inc hepatic vascular resistance- portal htn
causes ascites, hepatomegaly, splenomegaly, peripheral edema, esophogeal varices
how do you tx hepatorenal syndrom
liver transplant
management for pt with bleeding esophogeal varices
TIPs, propranolol
alcohol withdrawl syndrome is tx with
BB (for tachycardia), benzo (sedation), a2 agonist (ans hyperactivity), alcohol
disulfiram- used as a part of alochol abstinence program- not for acute withdrawl
what comes from adrenal cortex
alosterone-> sodium reabsorption
what comes from adrenal medulla
inc epi and NE-> systemic vasoconstriction
what comes from atrium
natriuresis
what comes from post pit gland
inc antidiuretic hormone- aquaporin synthesis and insertion in renal collecting ducts
what should be avoided in hyperthyroid
levothyroxine
when does glucosuria happen
> 180 mg/dL
what is expected with acromegaly
-oversecretion of growth hormone after adolescence
-large tongue (macroglossia) and epiglottis
-subglottic narrowing along vocal cord enlargement
-turbinate enlargement
-OSA
etiologies of addisons
autoimmune (most common in US)
adrenal tumor
TB (most common worldwide)
dm1
trauma
hiv
hitt
what should you avoid in someone with thyroid storm
amiodarone
what should you not give with hypercalcemia
LR- b/c it contains calcium
which of the following is true?
1. an excess causes muscle wasting
2. mineralcorticoid acitvity inc serum glucose
3. it engages w receptors on cell membrane
4. it inhibits insulin release
1
cortisol is a glucocorticoid- raises serum glucose through gluconeogenesis
also has some mineralcorticoid proterties - leads to na retention , k secretion, h secretion (think aldosterone)
it does not interact with membrane bound receptors- delayed onset of action
drug class of glipizide
sulfonylurea
drug class of pioglitazone
thiazoilidinedione
drug class of exenatide
glp 1 agonist
complications of conns syndrome
hypokalemia and htn
insulin in shortest to longest acting
humalog, humulin R, humulin N, lantus
what do you give if carcinoid syndrome becomes hotn
somatostatin (octeotide or lanreotide)- inhibits release of vasoactive substances from carcinoid tumors
graves disease has inc or dec T4/ TSH
graves= hyperthyroid
inc free T4
dec TSH
s/s of graves disease
insomnia
protein catabolism and wt loss
expothalmos
anxiety
ht intolerance
steroid potency compared to cortisol: aldosterone, methylprednisone, fludrocortisone, decadron
aldosterone 0x
methylprednisone 5x
fludrocortisone 10x
decadron 25x
what is the cause of endemic goiter
iodine deficiency
addisons disease symptoms
hyponatremia
hyperpigmentation
hyperk
severe hypovolemia (na and cl wasting)
shock like state from decreased co
death within 3d- 2weeks
decrease mineralcorticoid (aldosterone) production; decreases glucocorticoid (cortisol) production
-surgery, sepsis, trauma poorly toelrated- can elad to death
what increases growth hormone secretion
stress, anxiety, surgery
physiologic sleep
hypoglycemia
dec free fatty acid levels
inc blood amino acid levels
fasting
dopamine
alpha adrenergic agonists
estrogen
not corticosteroids or pregnancy
hyperthryoid anesthesia considerations
-even mild no elective procedures unless euthyroid
-inc sensitivity to muscle relaxants
-mac unchanged
-higher risk of corneal abrasion
-bb good
-inc risk for pathologic fractures during positionign
cv changes accompanying a normal pregnancy include increased
HR, sv, plasma volume
dbp decreases
sbp unchanged
a pregnant mom has hx of mitral stenosis. when is greatest risk of hemodynamic compromise?
third stage of labor
what are the effects of progesterone?
decreased mac, decreased paco2, increased sensitivity to LA
side effects of beta agonist therapy for preterm labor
maternal hypokalemia, hyperglycemia, tachycardia
what LA is least likely to undergo fetal ion trappign
chloroprocaine
fetal bradycardia is a common complication of which block
paracervical
when is the best time to perform non obstetric surgery on pregant patient
2nd trimester
cardiovascular complications of chronic maternal cocaine abuse include all the following except
anemia
what is youngest pca for surgery
60 weeks
what are most reliable indicators of recovery in neonate
max insp force better than -25
flexion of knees to chest
neonates will not follow commands
what is not an acute tx for postintubation laryngeal edema:
-nebulized racemic epi
-heliox
-cool and humidified oxygen
-decadron 0.5 mg/kg iv
-decadron
what congenital heart defects are associated with ventricular outflow obstruction?
tetralogy of fallot
pulmonary stenosis with ASD
can you use nasopharyngeal airways with cleft lip/ palate
yes
